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LCP Proximal Tibial Plate 3.5. Part of the Synthes Small Fragment LCP System.

Surgical Technique

This publication is not intended for distribution in the USA.

Instruments and implants approved by the AO Foundation.

Image intensifier control

This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended.

Processing, Reprocessing, Care and MaintenanceFor general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceFor general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

LCP Proximal Tibial Plate 3.5 Surgical Technique DePuy Synthes 1

Introduction

Surgical Technique

Product Information

MRI Information 19

Table of Contents

LCP Proximal Tibial Plate 3.5 2

AO Principles 4

Indications and Contraindications 5

Implantation 6

Cleaning of Instruments 14

Implants 15

Sets 17

2 DePuy Synthes LCP Proximal Tibial Plate 3.5 Surgical Technique

The LCP Proximal Tibial Plate 3.5 is part of the Small Frag-ment LCP System, which merges locking screw technology with conventional plating techniques.

The LCP Proximal Tibial Plate 3.5 has a limited-contact pro-file. The head and neck portions of the plate accept 3.5 mm Stardrive or hexagonal locking screws. The screw hole pat-tern allows a raft of subchondral locking screws to buttress and maintain reduction of the articular surface. This provides resistance to local depression loads in addition to the stabil-ity of the fixed-angle construct created by locking the screws into the plate.

The Locking Compression Plate (LCP) has combi-holes in the plate shaft which combine a dynamic compression unit (DCU) hole with a locking screw hole. The combi-hole pro-vides flexibility of axial compression and locking capability throughout the length of the plate shaft.

LCP Proximal Tibial Plate 3.5. Part of the Synthes Small Fragment LCP System.

LCP Proximal Tibial Plate 3.5 Surgical Technique DePuy Synthes 3

Combi-holes combine a DCU hole with a threaded locking hole

Three 2.0 mm holes for Kirschner wires and sutures

Undercuts added to Kirschner wire holes to allow for suture needle passing

Accepts Articulated Tension Device (to provide compression or distraction)

Proximal bend lower than standard plate

Elongated combi hole to aid in plate placement

Angled locking holes to support medial fragments

Four locking screw holesStandard bend plate

Low bend plate

Plate shaft Available with 4, 6, 8, 10, 12, 14, or 16 screw holes. The three locking holes distal to the plate head accept

Locking Screw B 3.5 mm (Stardrive or hexagonal) or Cortex Screw B 3.5 mm or Shaft Screw B 3.5 mm to secure plate position. The hole angles allow the locking screws to converge with three of the four locking screws in the plate head to support medial fragments.

Combi-holes, distal to the three angled locking holes, combine a DCU hole with a threaded locking hole. The combi-holes accept Locking Screw B 3.5 mm (Stardrive or hexagonal) or Cortex Screw B 3.5 mm or Shaft Screw B 3.5 mm in the threaded portion of the hole and Locking Screw B 3.5 mm (Stardrive or hexagonal) or Cortex Screw B 3.5 mm or Shaft Screw B 3.5 mm in the DCU portion of the hole.

Available in left and right plates, in implant quality 316L stainless steel or pure Titanium (TiCP).

Plate head Anatomically contoured to match the lateral proximal

tibia. Four convergent threaded screw holes accept:

Locking Screw B 3.5 mm (Stardrive or hexagonal) Cortex Screw B 3.5 mm Shaft Screw B 3.5 mm

Three 2.0 mm holes for preliminary fi xation with Kirschner wires, or meniscal repair with sutures.

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4_Priciples_03.pdf 1 05.07.12 12:08

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2.

1 Mller ME, M Allgwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.

2 Redi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

4 DePuy Synthes LCP Proximal Tibial Plate 3.5 Surgical Technique

AO Principles

1 Mller ME, Allgwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer. 1991.

2 Redi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1,2.

LCP Proximal Tibial Plate 3.5 Surgical Technique DePuy Synthes 5

Indications Split-type fractures of the lateral tibial plateau Lateral split fractures with associated depressions Pure central depression fractures Split or depression fractures of the medial plateau

ContraindicationsIsolated shaft fractures.

Note: For associated shaft fractures is recommended to use a stronger plate such as the 4.5 mm LCP PTP or the 4.5 mm PLT/LISS plates for obese patients. In all cases an adapted reduced post-operative mobilization is manda tory.

For contraindications of Norian Drillable or chronOS Inject see the corresponding surgical techniques (Norian Drillable DSEM/BIO/0515/0032, chronOS Inject DSEM/BIO/1015/0040).

Indications and Contraindications

6 DePuy Synthes LCP Proximal Tibial Plate 3.5 Surgical Technique

1Preparation

Complete the preoperative radiographic assessment and pre-pare the preoperative plan. Determine plate length and in-struments to be used. Determine proximal screw placement and screw lengths to ensure proper screw placement in the metaphysis.

Position the patient supine on a radiolucent operating table. Visualization of the proximal tibia under fluoroscopy in both the lateral and AP views is necessary.

Required setA Small Fragment LCP Instrument Set is required when im-planting the LCP Proximal Tibial Plate 3.5.

Recommended additional sets Basic Instrument Set, for LC-DCP and DCP Small Fragment Instrument and Implant SetLC-DCP,

with self-tapping screws Bone Forceps Set Large Distractor Set Large External Fixator Set with self-drilling Schanz screws Periarticular Reduction Forceps Set Pelvic Implant Set, with self-tapping screws (for longer

length 3.5 mm cortex screws up to 110 mm)

Note: More detailed information on conventional and locked plating principles can be found in the Synthes Locking Compression Plate (LCP) surgical technique (DSEM/TRM/0115/0278(1)).

Precautions: Instruments and screws may have sharp edges or moving

joints that may pinch or tear users glove or skin. Handle devices with care and dispose worn bone cutting

instruments in an approved sharps container.

Implantation

X-ray template for right LCP Proximal Tibial Plates 3.5 (Art. No. 034.000.492)

X-ray template for left LCP Proximal Tibial Plates 3.5 (Art. No. 034.000.495)

LCP Proximal Tibial Plate 3.5 Surgical Technique DePuy Synthes 7

2Reduce articular surface

Note: Prior to reduction, application of an external fixator or Large Distractor (394.350) may facilitate visualization and reduction of the joint.

Reduce the fracture fragments and confirm reduction using image intensification. Fragments may be reduced using inde-pendent Kirschner wires; however, Kirschner wire holes are also provided on the plate to help achieve provisional reduc-tion, plate position, or fixation.

The locking screws do not provide interfragment or plate-to-bone compression; therefore, any desired compression must be achieved with traditional lag screws. The articular frag-ments must be reduced and compression must be obtained prior to applying the LCP Proximal Tibial Plate 3.5 with lock-ing screws.

Note: To verify that lag screws will not interfere with plate placement, hold the pl

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